Neighbourhood Midwives

We were very saddened to hear last week about the imminent closure of Neighbourhood Midwives. Neighbourhood Midwives started out as a private, independent midwifery company, but were commissioned by Waltham Forest CCG to offer continuity of care, free of charge, to women as part of a two year pilot following  “Better Births”. Neighbourhood Midwives have been highly valued by the families they care for, and are respected across the maternity community. 


Birthrights contacted Annie Francis, CEO of Neighbourhood Midwives, as soon as we heard the news, to offer our support. Annie recognises that people have lots of questions about what happened last week, and the future implications of this, but has emphasised that her immediate priority and that of her team is ensuring a smooth transfer of care for the women Neighbourhood Midwives have been caring for before Neighbourhood Midwives closes its doors tomorrow.


With that in mind, on Monday our Programmes Director, Maria Booker, spoke to Barts and Homerton NHS Trusts, and also Waltham Forest Clinical Commissioning Group. We have been impressed by the commitment of all those involved, many of whom were just as surprised as everyone else to hear the news, to ensure women do get both the continuity of care and the birth they were promised. Women who are due to give birth before the end of February have been prioritised and it is our understanding that those transfers of care have already happened/are in the process of being completed and remaining women are now being transferred. 


We have responded to all the women who have contacted us about the closure of Neighbourhood Midwives to provide more detailed information about next steps, and to let them know that we are here for them if they need any further assistance or support. This is the information that has been provided by Whipps Cross and Neighbourhood Midwives and our choice of place of birth factsheet . We will continue to monitor the situation to ensure women are receiving the care they expect.


Our Chief Executive, Amy Gibbs, has also contacted Baroness Cumberlege, the Chair of the national maternity review, about the broader concerns raised by the closure of Neighbourhood Midwives.


If you have any concerns about the closure of Neighbourhood Midwives, or would like any assistance or support with your care please contact us on advice@birthrights.org.uk.”

Birthrights responds to the CQC’s national maternity survey

Commenting on the findings of the CQC’s national maternity survey, Amy Gibbs, Chief Executive of Birthrights, said:

“It’s positive that overall 88% of women surveyed felt they were ‘always’ treated with respect and dignity during labour and birth, but other findings highlight areas where maternity care is failing to respect women’s basic rights.

“Every woman has the right to choose where and how she gives birth, yet 15% said they were not offered any choices about where to have their baby and a quarter said they were not always involved enough in decisions about their care during labour and birth.

“Above all, the findings underline how vital continuity of carer is to improving women’s maternity experiences, giving them time and space to ask questions and make decisions that are right for them. We know that seeing the same midwife through pregnancy, birth and afterwards can make all the difference and help ensure safety goes hand in hand with dignity and respect. Yet only 15% of women reported that the midwives who cared for them during labour and birth had been involved in their antenatal care.

“It’s clear we need renewed commitment and drive at national and local levels, to ensure the vision of Better Births is achieved for most women to have continuity of carer by 2021.”

The full findings of the CQC’s maternity survey 2018 can be found here.

Birthrights responds to the NHS Long Term Plan

Responding to the publication of the NHS Long Term Plan today, Amy Gibbs, Chief Executive of Birthrights, said:

“We are really pleased to see improving maternity care at the heart of the NHS Long Term Plan, particularly the commitment that most women will receive continuity of carer by March 2021. We know that seeing the same midwife through pregnancy, birth and afterwards can make all the difference to women’s experiences and help ensure safety goes hand in hand with dignity and respect. This ambition must be backed up by investment in recruitment, retention and training, so NHS trusts up and down the country can make this pledge a reality for all women and midwifes are equipped to deliver rights-respecting care.

“We also welcome the goal to give more women access to mental health support following birth. In line with the Plan’s general focus on prevention, we would like to see equal effort on doing everything possible to avoid trauma during birth. How women are treated during their pregnancy and childbirth is a major driver for whether they experience trauma, so it is vital that delivery of the NHS Long Term Plan embeds respect for women’s rights to dignity, autonomy, privacy and equality explicitly into maternity care.”

Notes
The new NHS Long Term Plan includes commitments to:
  • reduce stillbirths and mother and child deaths during birth by 50%
  • ensure most women can benefit from continuity of carer through and beyond their pregnancy, targeting those who will benefit most
  • expand support for perinatal mental health conditions

Reflections on 2018

Four weeks into being Birthrights’ new Chief Executive, I’m feeling very lucky to lead such a brilliant organisation and brimming with positivity and ideas for 2019. I’m blessed with a very talented team, engaged and expert Trustees, supportive funders, invaluable partners and a wider enthusiastic pool of people who share our mission to improve women’s experience of pregnancy and childbirth by promoting respect for human rights.

As 2018 draws to a close, we wanted to share our highlights from the year. And since it’s Christmas, here are our top 12. I’m so impressed by how much has been achieved by our small but perfectly formed team – showing why #smallbutvital charities are so important. Clearly, I can take no credit for these and my thanks goes to the team and my predecessor, Rebecca Schiller, who I’m delighted will be joining the Board of Trustees next year.

In 2018, we’re proud to have:

  1. Launched our biggest campaign yet on the right to maternal request caesarean section
  2. Responded to over 170 email requests for advice from women in need
  3. Seen our online factsheets visited over 7,000 times – a 7% increase on 2017
  4. Delivered 18 speaking engagements or training sessions to healthcare professionals
  5. Strengthened our links with NHS England, the Royal College of Obstetricians and Gynaecologists, Royal College of Midwives, General Medical Council, Parliamentary and Health Service Ombudsman, Public Services Ombudsman for Wales
  6. Engaged with the Maternity Transformation Programme Stakeholder Council and numerous NICE consultations
  7. Secured a new grant from the Esmée Fairbairn Foundation to expand our team and impact
  8. Progressed our Baring Foundation and Trust for London funded work on women with complex needs
  9. Welcomed new team members, trustees, Associate Trainers and accountants on board
  10. Improved our financial systems and capacity to report on budgets and grants
  11. Deepened our partnership with Leigh Day and explored other corporate partnerships
  12. Continued our crucial collaborative relationships with Birth Companions and BPAS

And much more besides… Merry Christmas and thank you to all our funders, supporters and partners – I look forward to meeting and working with you in 2019!

Recruiting new Legal Officer

Birthrights is the UK’s only organisation dedicated to improving women’s experience of pregnancy and childbirth by promoting respect for human rights.

The Legal Officer is a new and critical role at Birthrights to manage our advisory and legal work, including running the advice service, overseeing strategic litigation and providing legal policy input with core stakeholders.

This is a part-time home based role, with a pro-rata salary of £15,000. To find out more and how to apply please download the Job Description.

Closing date for applications is 5pm on Wednesday 27th June 2018.

Home birth – what are a Trust’s responsibilities towards midwives and women?

What are the responsibilities of midwives to care for women who have requested a home birth? And how can Trusts best support these responsibilities?

Midwives owe the women they care for a legal ‘duty of care’. They are obliged by the NMC Code to ‘put the interests of people using midwifery services first’ and to ‘make their care and safety [their] main concern’. Under human rights law, all Trusts and their employees are obliged to respect women’s decisions in childbirth and cannot compel a woman to receive care in a hospital.

If a woman has stated her preference for a home birth and informs the NHS Trust or home birth team that she is in labour, the woman can expect the midwife to attend her at home. Trusts that prevent midwives from attending a home birth for a woman under their care present their midwives with a difficult dilemma – to defy their employer and put the woman first, or obey their employer and neglect their duty of care. If a midwife does not attend a woman, and the woman or her baby die, there is a real risk that the Trust could have breached the right to life (Article 2 of the European Convention on Human Rights).

In recent weeks, a small number of Trust home birth policies have been brought to our attention, which have suggested that a home birth will only be offered if women agree to any interventions or examinations midwives propose, and in some cases that midwives should leave the labouring woman should their “offer” of an examination or intervention be declined. Legally speaking, women at home have as much right to decline an intervention or examination as in any other birth setting. And making a home birth conditional on this “agreement”, or threatening to leave constitutes bullying and it is very likely to be an unlawful interference in a woman’s right to make decisions in childbirth. If she were to consent to an intervention as a consequence of a threat to withdraw support for her home birth or abandon her care, her consent may not be valid, and the midwife could be liable for criminal assault/battery.

Some Trusts will argue that these policies are designed to protect their midwives from being put in a difficult position and a particular concern has been raised about situations where midwives are asked to wait outside the room while a woman is in labour. It is important to distinguish between a couple who asks for some time alone in labour, and asking a midwife to remain outside of the room for the duration of labour and birth and only be on hand in an emergency. If a woman makes the latter request, it may indicate a lack of trust for the midwife, which will not be assisted by a blanket policy prohibiting the midwife from providing care in those circumstances. Relationship building and individualised care planning are much more likely to lead to safe and positive outcomes.

Midwives are also under a duty not to exceed their scope of practice and their experience. Trusts should be open with women about any concerns they have about their staffs’ expertise to attend more complicated births, whether at home or in hospital. This conversation needs to be managed with sensitivity and while risks must be carefully explained and contextualised, the woman must not be threatened or pressured to accept any particular course of treatment.

Whilst dealing with a home birth that doesn’t go to plan can be stressful for the midwives involved, it is women who ultimately bear responsibility for their own informed decisions. Midwives who give women the best available evidence about a recommended course of action and any reasonable alternatives, document their explanation and discussion and then support a women’s informed decision to decline are upholding professional standards and their human rights obligations, and have nothing to fear from lawyers or regulators.

Finally, as NHS resources become more stretched, home birth services are too often cut back by Trusts. While Trusts may rely on staffing shortages for failing to send midwives to a home birth they should only do so if there is a genuine and unforeseen staffing shortage. If they are withdrawing the service on a regular basis, they can be expected to make alternative arrangements. In a recent case, the NHS Ombudsman accepted that an NHS Trust that refused to make contingency plans after it suspended its home birth services was acting unreasonably.

Trusts’ home birth policies should be based on respect for women’s informed decisions. Any policy that makes care conditional on acceptance of interventions, or threatens suspension of the service due to staffing shortages, does not respect women’s right to make informed decision, fails to put their interests first and risks their safety.

Our email advice service (info@birthrights.org.uk) is available to any woman who feels she is not receiving respectful maternity care and any healthcare professional who is concerned that they are being prevented from delivering respectful maternity care.

 

How should Health Care Professionals handle a maternal request for caesarean?

Its been unusually noisy in the maternity world over the summer, as media reports have reignited discussion about what a safe” birth looks like. At Birthrights we believe that the need to listen to women is the mast that all those who care about the safety of women and babies during birth, can cling to when the seas of discussion get rough. 

Many women want to avoid unnecessary interventions in childbirth and, on the 15th August, Birthrights CEO Rebecca Schiller wrote about the vital role midwifery care plays in ensuring women who don’t need and want intervention have the best chance of avoiding it safely

We have also been working hard to support a smaller but important group of women who feel a planned caesarean section is the right choice for them. We created our recent maternal request for caesarean campaign to ensure that these women’s voices were heard and to discover the barriers to their requests being granted

In this blog post, our Trustee, midwife Simon Mehigan, shares his experience of working with women who want a caesarean for no medical reason, and why the approach of a number of Trusts to shut off this option from the outset, is counter-productive.

“A few years I was employed as a consultant midwife at a large teaching hospital in the Northwest of England. One of my responsibilities was to see all the women requesting a caesarean section in the absence of what was considered to be a medical reason.

Over the course of three years I saw over 500 women. I saw the majority of these women just once with a follow up either by email or by phone. Some I saw twice and for a small proportion I took over all of their care, as it was apparent that continuity would have a significant impact on their decision-making. Here’s what I learnt:

Saying no initially to a womens request for an elective caesarean section creates an antagonistic starting point for discussion and doesnt reduce the overall caesarean rate.

I very quickly discovered that by telling women very early on in my conversation with them that “if a caesarean section is ultimately what you want I will help arrange that for you”, that they relaxed, were prepared to listen to what I had to say and were receptive to discussing alternatives.

In fact having met me and discussed their options, 85% of women opted to aim for a vaginal birth of their own accord and over 70% of those women ended up having a vaginal birth.

A couple of women actually informed me after our consultation that because I had said I would support them in their request for a caesarean section that they no longer wanted one. Being told “no” by consultants had made them more determined to have a caesarean section because they were not prepared to let someone else make decisions about their birth.

A de-brief of their last birth often alters a womens view.

A number of women didn’t understand what happened to them last time. Going through it with them, explaining why things might have happened often helped women in realising that things could be different in this new pregnancy and birth.

After 28 weeks it is more difficult to alter the view that caesarean section is the right choice

Many Trusts schedule these conversations for the last few weeks in pregnancy and yet what I experienced was a direct correlation between the gestation at which I met women for the first time and whether they would be open to explore options that might ultimately feel better to them than a caesarean section. The later I saw them the less likely they were to consider any other options.

The plans of care I developed in conjunction with the women often focused on having an uncomplicated birth with a low threshold for a caesarean section.

The majority of women I saw had had a previous traumatic birth experience. Common themes were a lack of control, lack of communication from staff and a negative experience of induction. Therefore the plans we made together often stated no induction of labour, no rotational forceps, minimal examinations and diverting to a caesarean rather than trying other interventions if the birth wasn’t completely straightforward

Once a decision had been made a line had to be drawn.

Women found it very stressful having to revisit their decision every time they met a health professional.

A caesarean is the right choice for some women.

I have over the years met many women that have felt a caesarean section was the right choice for them. They could all explain rationally why they wanted to birth their babies in that way.

By listening to them, talking to them as an equal and ensuring they felt in control of the process they not only developed confidence in their bodies but more importantly in their caregivers and the organisation irrespective of whether their final decision was to opt for a caesarean section.

In over 20 years as a midwife I have yet to meet a woman that has made irrational decisions or choices. They have always been the right choice for that women based on her individual circumstances.”

Simon Mehigan

Do I have a right to a c-section? Update on Oxford University Hospitals

On 24th May we launched a campaign to engage with Trusts who state that they do not offer maternal request caesarean sections, thereby denying women the individual respect and consideration they are entitled to. The first Trust we wrote to was Oxford University Hospitals whose policy on offering planned caesarean sections is stated in this leaflet:

http://www.ouh.nhs.uk/patient-guide/leaflets/files/10405Pcaesarean.pdf

OUH responded to our original letter stating that their approach was in full compliance with NICE guidelines, and that they offered a “kind, friendly and professional service”. Unfortunately the reports we have received of women not being listened too, being left shaken by consultations, and being left distressed and anxious knowing that their request for a caesarean section would not be granted by OUH, are at odds with OUH’s account.  Therefore, this week, we wrote again to the Trust, their Commissioners, Healthwatch Oxfordshire and the CQC, to share some of your stories and to urge them to reconsider their approach. If you would like to tell us about your experience or requesting a maternal request caesarean section at OUH or elsewhere, please comment below…

Letter to R Schiller (Birthrights) from OUH

Second letter to OUH from Birthrights with case studies

Birthrights on Mumsnet

We’re really pleased to announce that we have not only updated our own set of factsheets, but have partnered with Mumsnet, to update our answers to their most frequently asked questions about rights relating to pregnancy and birth.

You can find Mumsnet users’ questions and our answers here. Ranging from common concerns about the right to an epidural or a homebirth, to more specific questions about water birth and antenatal check-ups our work with Mumsnet helps us to give definitive answers to millions of women.

We’ve grateful once again to the team at Mumsnet HQ for the chance to speak directly to so many women directly affected by these issues.

About Mumsnet

Mumsnet is the UK’s largest network for parents, with over 10.5 million unique visitors per month clocking up over 100 million page views. It has 170 local sites and a network of 10,000 bloggers and vloggers. It regularly campaigns on issues including support for families of children with special educational needs, improvements in miscarriage care and freedom of speech on the internet.

Mumsnet logo

 

New human rights i-learn course

The Royal College of Midwives and Birthrights today launched a new i-learn module on human rights, which is available to all RCM members.

Birthrights CEO, Rebecca Schiller commented: “With the launch of A-EQUIP planning complex care will not longer be down to a specialist. Therefore all midwives and maternity workers need to understand how human rights law can empower them to advocate for women, and to plan individualised care. This i-learn module created by the RCM in collaboration with Birthrights is an important contribution to further training midwives for this role.”

You can see the full press release here.